Management, Presentation of ACT
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- Congenital: (caused by lesions in SCM (childbirth trauma), vertebral defomities e.g Hemivertebra, klippel feil)
- Acquired: post trauma (within days or 3-12 months)/adjacent inflammatory process (Osteomyelitis,lymphadenitis, pharygitis, tonsilitis, cervical abcesses, tumour, RA, Partial dislocation of C1 on C2 - Spasmodic: Cervical Dystonia - unknown origin - Acute: Benign - affects younger and middle aged patients , sudden onset -self resolves days/weeks - Dermatogenic: When the skin of the neck is injured it shortens (scars/burns) - Occular: Compensational paralysis of the muscles that control inclination and rotation of the head - oblique extraoccular muscles |
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- Patient remembers doing something strenous or new the day before
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- On observation patient has painful fixed posture of lateral flexion and contralateral rotation of the head (can have flexion, extension, right/left tilt)
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- Movement is painful and ROM is limited (lateral flexion and extension to the side of pain)
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- Sleep is disturbed
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- +ve Spurlings
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- Palpation reveals unilateral hypertonicity/spasm of the SCM, traps and LS
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- Intersectional joint restricion
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- Assess shoulder, scapular girdle
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- Check for patient's drugs - Dopamine blockers, Ketamine, ammphetamines, cocaine, compazine, haldol and thorazine
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- In patients with Down syndrome with torticollis, consider atlanto-axial instability
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- Assess for s/s of cervical adenopathy (lymph nodes), oropharynx, otoscopy, fundoscopy
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- Essential Tremour
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- Myasthenia Gravis
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- MS
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- Neuroleptic agent toxicity
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- Parkinsons
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- Peritonsillar Abscess
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- Rehabilitation and cerebral palsy
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- Retropharyngeal Abscess
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- Spinal Haematoma
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- Tardive Dyskinesia
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- Wilson disease
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Usually unnecessary unless:
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- Trauma and "red flags"
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- Fever (infection/inflammatory - usualy septic otolaryngological/osteoarticulr infection)
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- Swollen Lymph nodes
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- Significant headache
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- Difficulty breathing, swallowing or speaking
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- Ataxia
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- Weakness, numbness or parasthesia in extremities
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- Change in bladder/bowel habits
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- Strabismus
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- Nystagmus
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- Increased ICP (Vomiting, Double vision, Confusion, headache, papiloedema)
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- Reccurent vomiting
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- More serious causes should be ruled out
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- Ice/heat
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- Myofascial release of SCM, traps, LS and paraspinal muscles
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- Stretching - Cx tractioning whilst resting your forearms on the patient's shoulders, forearms downward pressure, then ask patient to push against forearms with their shoulders against your resistance for 5-7 seconds while inhaling, ask patient to exhale and then stretch out and increase traction, process should be repeated 3 times
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- Scapula repositioning
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- SMT if tolerable
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- Avoidance of sleeping on the stomach or drafty conditions
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- Cervical pillows recommended
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- NSAIDs and counterirritant creams, Benzodiazepines, muscle relaxants, anticholinergics, botox
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- Surgery for some types
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